Background Low-grade endometrial stromal sarcoma (LGESS) is a rare gynecological malignancy. For LGESS patients at stage Ⅰ, the value of postoperative adjuvant treatment on its prognosis is inconclusive. At present, its clinical treatment is to administer hormone therapy to patients with pathological immunohistochemistry positive for progesterone receptor (PR).
Objective To investigate the effect of postoperative hormonal treatment in LGESS patients at stage Ⅰ with PR positive, and analyze the influencing factors on the prognosis.
Methods A retrospective comparative clinical study was conducted in 33 PR–positive and LGESS patients at stage Ⅰ who were treated in our hospital from June 1992 to October 2021. All patients were confirmed by pathology, and their pathological immunohistochemistry showed positive PR. According to whether hormone therapy (synthetic progesterone or estrogen progesterone combination therapy) was given, the patients were divided into treatment group and observation group, the impact of hormone therapy and related factors on its prognosis were analyzed.
Results Of the 33 cases, 13 patients were included in the hormonal treatment group and 20 patients in the observation group. With the exception of postoperative radiation (P=0.026), there were matched in age, marital and menopausal status, surgical scope, and postoperative chemotherapy. The differences were not statistically significant in PFS, OS, mean PFS (78.15 months vs 63.65 months) and mean OS (103.08 months vs 79.85 months) between the hormonal treatment group and the observation group (all P>0.05). Of the 33 cases, 11 patients had a hysterectomy with ovarian conservation, and 10 cases underwent radiotherapy. The differences in PFS and OS between the ovarian preservation group and the bilateral salpingo oophorectomy group, and in PFS and OS between radiotherapy group and without radiotherapy group were not statistically significant (all P>0.05).
Conclusion Hormonal treatment should be carefully selected for postoperative low-grade endometrial stromal sarcoma patients at stage Ⅰ with PR positive expression, although the mean PFS and OS in hormonal treatment group are prolonged compared with the control group, the differences between the two groups are not statistically significant. The result should be further studied with a larger sample size.